Assessment of HER‐2/neu overexpression and/or gene amplification in breast carcinomas: should in situ hybridization be the method of choice?

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Abstract
Aims: Since the release of Herceptin®, pathology laboratories have been requested to test breast carcinomas for HER‐2/neu overexpression and/or gene amplification. Standardized IHC and FISH are mandatory in order to get reliable results, but there are problems even with standardized procedures. We decided to evaluate the two methods to determine which, or possibly if both, should be the primary investigation method(s).Methods and Results: The material consisted of 215 primary invasive breast carcinomas with complete clinical follow‐up of 15 years. HER‐2/neu protein expression was determined for all specimens, whereas FISH for assessing HER‐2/neu gene signal number was done in 165 cases. IHC was double‐checked with two or three different antibodies in 35 tumours, including all cases with discrepancies between IHC and FISH. Among these, there were discrepancies in a third. IHC overexpression of HER‐2/neu was found in 13% and gene amplification in 18%. Discordance between IHC and FISH was found in 11 cases (8%). Five tumours were IHC+/FISH− and six were IHC−/FISH+. IHC and FISH positive cases as well as FISH only positive tumours had the same prognosis respecting survival. Tumours with >2 but ≤4 HER‐2 gene signals per nucleus had the same survival as cases with >4 gene signals per nucleus. In contrast, cases with IHC overexpression without gene amplification had a prognosis similar to that of IHC−/FISH− tumours.Conclusions: From our data, it seems to be more important to assess HER‐2/neu gene amplification than IHC overexpression. Failure to detect FISH‐amplified (IHC‐negative) cases would have an adverse effect on the survival of these patients. On the other hand, IHC overexpression tumours without gene amplification appear to belong to a better prognostic group, and failure to detect them would probably not have a negative effect on the survival of these women. Even though FISH is a more complex and expensive procedure, it should be considered the method of choice for primary assessment of HER‐2/neu status in breast cancer patients.